GI-IBD Flashcards
Is IBD and IBS the same?
NO IBD- chronic recurring inflammation of GI tract d/t dysregulated immune response industrialized, urban, north Ulcerative Colitis Chron's Indeterminate colitis- overlap of both
Which condition is biomodal?
M UC young and late
F CD young and late
Causes; genetic, mucosal immune system dysregulated, Environmental Triggers
HIgh protein
Which disease has bloody diarrhea from the mucosa and submucosa from ALWAYS rectum to proximal colon +/-?
Ulcerative Colitis 10-20 bowels/day Frequency, urgency Tenesmus- crampy rectal sensation prior to defecation w/o stool Nocturnal bowel movements
What sx of UC may overlap with other GI?
Abdominal pain
Fatigue
Anorexia
Wt. Loss
What does a colonoscopy discover as a diagnosis of UC?
erythema
Mr. Rex c/c of bloody diarrhea 10x /day, loss of 10lbs recently. During colonoscopy he had 100% rectal damage, confluent to proximal colon. NO perianal fissures or strictures.
Ulcerative colitis
What is the protective factors benefit of UC?
smoking
appendectomy
How is the microbiome different in IBD?
UC and CD less diversity in bacteria
Depleted microbiome
What are benefits of microbiome?
metabolize CHO
Vit and hormone production
Immune develop
mucosa protection
Which drug dec. inflammation in wall of intestine primarily for UC?
5-Aminosalicylates 5-ASA
Which disease affects from mouth-anus, interspersed, skip lesions, but healthy tissue in other locations?
Chron's Dz LOC Perianal- MC- abscess, fissures, fistulas Illeocolonic MC Small bowel Colon Stomach/duoden LC
What are lining mechanisms due to deep punched out ulcers ?
Abscess - GI tract getting weak- If it doesn’t find an opening to relieve the pressure
Fistula- finds opening to relieve the pressure
Stricture- narrow
What is fissures, low/high fistulas, abscess, anorectal strictures, hemorrhoids and anal ulcers?
Perianal Disease
1/3 develop prior to CD sx
what are classic sx assoc with Chron’s Dz?
- Diarrhea
- Blood in stool
- Abdominal pain
- Weight loss, weakness and anorexia
DX- determine CD vs UC
Ms. Beta has noticed her daughter has started to avoid raw vegetables, salad, broccoli? What and why might this be.
Stricturing in SMALL bowel assoc with Chrons– nausea, vomiting, bloating, food aversion Diarrhea, usually non-bloody Abdominal pain Fever/weight loss/anorexia Malabsorption/malnutrition
Ms. Beta fever, malaise, weight loss, wt/ diarrhea and bloating. What is concerning with this sx
Perforation
SX- Fever unknown orgin, Sepis
What will colonoscopy, CT or MRI reveal?
DX for Chron’s vs. UC
Transmural ulcers- include all layers
lesion dispersed
Punched out ulcers
Damage-Rectal +/- , perianal, strictures, illeum involved
Patchy distribution of inflammation in GI tract
What is most challenging with IBD tx?
Flares Pt stop meds until flare Inconsistent btwn pt Cost ADE
What are goals with TX
Maintain clinical remission- cut down bowel 20 to 4 per day, no blood in the stool
iii. Heal mucosal lesions
iv. Decrease hospitalization/surgery
v. Minimize disease and treatment-related complications
What influence the response of TX for IBD?
i. Ulcerative colitis or Crohn’s disease
ii. severity
iii. Anatomic location
iv. Previous response to medications
v. Side effects of medications
vi. Comorbidities
vii. Patient preferences
What agent are used for mild IBD, Modifies activity of immune system to reduce inflammation.
Immunomodulators: CHRONIC IBD prior to Steroids a. 6-mercaptopurine (6-MP) b. Azathioprine (AZA, prodrug of 6-MP) c. Methotrexate (MTX) Used in IBD for 30y ,*** Slow onset of action (~ 6 months)
ADE
a. **Infectious complications
b. Myelosuppression 5%
c. Transaminase elevation- Cholestatic hepatitis <1%
d. Pancreatitis 3%
e. Fever/myalgia 2%
f. Nausea/dyspepsia up to 20%
g. Lymphoma rare
h. Increase in non-melanoma skin cancers
i. Up to 20% d/c
What is use to treat MOD or MILD IBD?
Budesonide- induce remisson, not maintenance. Affinity for GI tract
Less ADE than Prednisone
***Corticosteroid Prednisone- acute flares of IBD ADE Short-Term: i. Weight gain ii. Fluid retention iii. Sleep disturbance iv. Mood swings v. Acne
b. Long-Term:
i. Infection
ii. Bone loss / osteoporosis
iii. Cataracts / Glaucoma
iv. Skin fragility
v. Hypertension
vi. Diabetes
Which agents are used for severe IBD along with surgery, and target TNF and it neutralizes it so it can’t propagate inflammation?
Biologics- Anti-TNF Injections- Remicade, Humira, Cimzia, Simponi
40% response, habituate
Cost>15K/yr
WHat molecule in the body is a key factor in inflammation. neutralize this molecule increase you risk to infection b/c our inflammatory response is not there
a. TB reactivation
b. Hepatitis B reactivation
c. Reactivation of opportunistic infections
d. Autoimmunity
e. Malignancy / lymphoma
f. Neurologic events/ demyelination syndromes
g. Cardiovascular events
h. Deaths
Tumor necrosis factor
